Month: March 2024

 

(DTCA – All About Lawsuits)

From diabetes to arthritis, we all want to cure our health issues. But does our desperation give pharmaceutical companies the right to advertise directly to us? Let’s explore DTCA (direct-to-consumer advertising), and all its’ shades of grey.

(ResearchGate)

DTCA is the practice of pharmaceutical companies advertising their products directly to their target population, through the internet television, or other media (Health Charities Coalition of Canada). Canada’s FDA prohibits DTCA by preventing the promotion of any drug as a cure, treatment or prevention to serious diseases like cancer, diabetes, etc. (DTCA in Canada – NIH). Despite government regulation, at the end of the day shouldn’t it be every business’s right to advertise their product? Not exactly. Over 20% of new Canadian drugs receive ‘black-box’ warning (having caused severe side-effects/death) after airing ads, highlighting the importance of DTCA regulations (DTC prescription Advertisements in Canada). The back and forth of companies wanting to advertise, while considering the seriousness of the product is primarily why this such a controversial social issue.

(Pharma Marketing Network)

(ResearchGate)

Deciding whether DTCA should be allowed or not, requires considering both sides of the argument. One reason against DTCA is over-prescription. Three Canadian studies between 2000-2002 found that 48% of physicians didn’t agree with DTCA drug referrals, yet still prescribed them for the patient’s peace of mind (DTC advertising and prescribing), demonstrating serious impact on patient care and prescription patterns (DTC advertising and prescribing). This over-prescription directly impacts healthcare costs. Because so many government-led programs pay for brand-name prescription drugs, vastly more expensive than generic counterparts, these schemes utilize increasingly higher amounts of tax dollars (Dangers and Opportunities of DTC Advertising). Less money goes into resolving bigger health determinants like SES/food deserts, which more immensely impact health.

Another major issue is misinformation. When ads list dangerous side-effects like the visuals try to illicit classical conditioning (Public Health Effects of DTC Drug Advertising). Someone happily playing with their dog gets associated with the drug, demonstrating the manipulative tactics used to lure people into becoming ill-informed customers. A study from the US found that amongst 97 advertisements, 0% provided adequate information regarding risks, and over 13% promoted an off-label use, which isn’t allowed as per FDA rules (Dangers and Opportunities of DTCA) demonstrating the manipulation DTCA uses to draw attention away from risks, towards the over-exaggerated benefits. While perhaps beneficial in some ways, DTCA manipulates vulnerability for profit.

(AAMC)

While reasons against DTCA are valid, many reasons support it as well. When drug dispensaries first became publicly available, it revolutionized healthcare by giving people the opportunity to take charge of their own health, which is something I believe we take for granted today (The Emergence of the Drug Dispensary – Module 5). DTCAs are also excellent at informing the public about their treatment options. A study in 2004 found that 73% of physicians believed that DTCA helped their patients ask more thoughtful questions (DTC Pharmaceutical Advertising – NIH). This encourages conversations between patients and physicians thus improving disease awareness and health outcomes (Direct-to-Consumer Advertising and the Patient–Prescriber Encounter – NIH). In today’s 15-minute appointment world, people taking initiative for their health and reaching out to doctors allows for better health literacy/discourse, and quicker treatment (Understanding Health Literacy – CDC).

(Propulsid – Myportfolio)

Organization like the FDA claim to “maintain comprehensive surveillance of medications to both consumers and physicians”, however many examples show it’s not enough. Propulsid was a gastric reflux drug heavily marketed to US consumers for 7 years before it was “black-boxed” due to high incidences of fatal heart arrythmias (DTC Pharmaceutical Advertising). Janssen the parent company, marketed Propulsid as a magic bullet; a drug only affecting the disease/issue and harming nothing else in the body (Magic Bullet Treatments – Dr. Duffin). Just looking at the advertisement, manufacturers used misleading graphs to lure consumers, while in fine print stating that it actually showed no effect in clinical trials. This demonstrates a clear example of DTCA being fatally misleading, and why it’s wrong.

Overall, I oppose DTCA. DTCAs sometimes use ghost-written studies where clinician academics ”co-investigate” heavily biased studies, but publish results as “properly conducted” (Ghost Management and Ghost Writing – Module 5) causing disease mongering by creating a demand for an issue that isn’t really there (Disease Mongering – Module 5). This leads to many drugs being ‘black-boxed’ with parent companies under-advertising risk and over-advertising benefits; why YOU need THIS drug NOW. Perhaps combatting DTCA misinformation requires imposing stricter regulations and gaining a better understanding of our healthcare system and our doctors’ choices. Decreasing prescription dependence, and increasing herbal medicine consumption can also help (Plant-Based Treatments – Dr. Duffin). Normally for a cold, instead of taking pills I drink “haldi doodh”, an ayurvedic plant-based drink that combats inflammation, to feel better.

I acknowledge that all DTCA pharmaceuticals aren’t inherently “evil”; and ultimately it’s up to the consumer to “talk to their doctor and see ­­if ___ is right for them”. However, DTCA poses risks like over-prescription, and manipulative/misinformed advertising which harm patient care, and strain healthcare systems. This is why I believe it shouldn’t be allowed.

Alamy – Drug Addiction Concept

Hit after hit, the agonizing, insatiable urge never ceases. According to the NIDA, addiction is a chronic disorder that’s “characterized by compulsive drug [and alcohol/medication] [mis]use despite [knowing] adverse consequences” (NIDA- Drug Misuse and Addiction). I believe calling addiction a disorder undermines the severity of its physical effects… ones that do more than just “disrupt normal body functions” (verywellhealth). Let’s take a deeper look into addiction: disease vs disorder, shall we?

ResearchGate

Following in Vesalius’s footsteps, “pathologists” Bonet and Morgagni were critical in the development of nosology away from religion, toward pathology. Bonet’s contributions to abnormal anatomy were pivotal in creating Morgagni’s “Seats and Causes of Disease” (Pathology In Pre-Modern and Modern Eras) which connected disease to physical anatomical changes deviating from normality (Pathology In Pre-Modern and Modern Eras). Modern pathology not only looks at a specific anatomical/bacteriological disease elements, but the cause and effect. For substance-use addiction, dopamine is fired in the brain, creating euphoria that reinforces the consumption of the substance enticing it (NIDA – Drug Misuse and Addiction).

CSUH – Substance Use Costs In Canada 2020

When classifying disease, the Hippocratic triangle (representing a disease concept) teaches us that amongst the 3 facts of disease (illness, patient, and observer) (Disease Triangle), the observer has most importance in defining the condition (Pathology From Antiquity To the Renaissance – Dr. Duffin). Dr. Duffin states how pathologists discover diseases by recognizing symptoms, assigning an anticipated cause and finding a treatment/prevention or outcome (Pathology From Antiquity To the Renaissance – Dr. Duffin). All these can be identified for addiction. Encouraging more dialogue in the medical community can help those who have power to reconsider their definition and shine a spotlight on the severity of addiction, saving lives.

 

Alongside helping, medical professionals can delay constructive action when physiological cause-based theory is used to describe addiction. It encouraging patient blaming and stigma propagation with terminology like junkie, or clean instead of not using (Stigma of SUD – Drug Misuse and Addiction PHAR100). Such language causes isolation and societal shame when asking for help, thus preventing outreach (Theories of Disease). Labelling addiction as a disease would bring validity to concerns, and courage to the afflicted for self-advocation. With 47000 deaths linked to substance abuse yearly (addictionhelp – Canadian Addiction Statistics), defining it as a disease can help change attitude toward its seriousness; improving treatments, saving lives and uplifting voices reaching for support.

CCSA – Canadian Drug Summary

When looking at why substance-use addiction shouldn’t be considered a disease, let’s understand why people misuse. Neuroscientist Carl Lewis states that addiction isn’t a disease, but rather “deep learning triggered by stress or alienation… unlearned [with] stronger synaptic connection[s]” (NDARC UNSW Sydney). I can mostly agree with his belief, as it essentially states that ontological cause-based theory contributes to addiction (Theories of Disease). External (ontological) factors like abuse, isolation, and peer pressure increase your likelihood of developing substance-use addictions (Mayo Clinic – Drug Addiction). Regarding internal genetic factors, Professor of health Dr. Suzanne Fraser states, “geneticists… acknowledged that genes [are] too complex to [be addiction’s main] cause” (NDARC UNSW Sydney). It’s possible that social issues encouraging addiction are too interwoven to understand, so we overstate genetic contribution to stop people from feeling guilty. Tackling instead the social issues that encourage addiction is more proactive in its treatment/prevention and possibly, wholistically better for the afflicted.

statcan – Primary Health Care Providers

In 2023, the Canadian government pledged $359.2 million over 5 years for a “renewed Canadian Drugs and Substances Strategy” (Government of Canada). Before we rush to put more money into research/awareness for addiction, we must ensure current resources are adequately distributed to necessary levels of our health care system for everyone. Did you know that almost 15% of Canadians claim to not have a regular primary physician (Statistics Canada)? Classifying addiction as a disease could put excess strain on the system, decreasing quality of care for others. Organizations like CAMH devoted to addiction research/treatment/social destigmatization while calling it a disorder, further shows me the unnecessity of labelling it a disease. Some professionals claim addiction’s “cause” to be a dopamine hypothesis (Dopamine Hypothesis – Drug Misuse and Addiction PHAR100) meaning that since it isn’t a definitive cause, addiction can’t be a disease. Furthermore, addiction being self-inflicted and not necessarily having a physical cause (a tumor, virus, etc.) denies it disease classification (Is Addiction A Disease of a Choice? – americanaddictioncenter).

CBC News – Thousands of Canadian drug users dying as government red tape limits help, advocates say

Regardless of it being a disease or disorder, addiction causes serious suffering to millions of Canadians yearly. I see the physiological cause-based theory hurting people by instilling stigma, while recognizing that addiction is already medicalized (Medical Model of Disease Today), and support systems are currently in place for willing participants. I also understand the limitation of protecting 47000 lives lost yearly, to the immorality of sacrificing healthcare quality for 40 million people. Overall, the continual rise of substance misuse (increasing incidences of addiction/death) (NIH – Drug Misuse In Canada), makes considering it a disease the right choice. However, instead of stretching an already tight budget, let’s expand the wallet and fill it with societal reform and monetary contributions for research/treatments. Changing mindsets is something we can start today, so let’s get to it!